Provider Demographics
NPI:1881204808
Name:CAWTHORNE, SHAVONDALI HARRIS (FNP-C)
Entity Type:Individual
Prefix:
First Name:SHAVONDALI
Middle Name:HARRIS
Last Name:CAWTHORNE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:945 BELLEVUE PLANTATION RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-6122
Mailing Address - Country:US
Mailing Address - Phone:318-469-6245
Mailing Address - Fax:
Practice Address - Street 1:945 BELLEVUE PLANTATION RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-6122
Practice Address - Country:US
Practice Address - Phone:318-469-6245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA215089363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily